Expectations, Anxiety, Depression, and Physical Health Status as Predictors of Recovery in Open-Heart Surgery Patients

BACKGROUND AND OBJECTIVES: Recovery after open-heart surgery is a complex process that presents psychosocial and physical challenges that continue well after discharge. The purpose of this study was to examine the relationship among expectations, anxiety, depression, and physical health status (PHS) and to determine predictors of postoperative PHS in open-heart surgery patients. PARTICIPANTS AND METHODS: A convenience sample (N = 54) was recruited from 2 hospitals in rural regions from 2 different mid-Atlantic states. The sample included participants who underwent coronary artery bypass graft or valve replacement surgery for the first time. The study used a longitudinal design, and data were collected preoperatively in the hospital or surgeons' offices and 4 weeks postoperatively by telephone interviews. Participants were interviewed using the following questionnaires: the Future Expectations Regarding Life with Heart Disease scale, the Hospital Anxiety and Depression scale, and the Medical Outcomes Study 36-Item Short Form Health Survey. Repeated-measures analysis of variance, Pearson product-moment correlations, and multiple regression were used for data analyses. RESULTS AND CONCLUSIONS: Statistical analysis revealed that anxiety (P = .002) and depression (P = .026) scores decreased postoperatively. Significant relationships were found among the preoperative and postoperative variables: expectations, anxiety, depression, and PHS. Analyses also found that preoperative expectations, anxiety, depression, and PHS contributed 38% of the variance of postoperative PHS (P < .001). However, the postoperative variables were not significant predictors of postoperative PHS (P = .075). The findings support the need for interventions to assist patients in developing realistic expectations and for clinicians to screen patients for anxiety and depression before and after surgery. Future research needs to measure PHS at various times postoperatively to identify continued limitations after surgery.